Synopsis
Convert cancer-treatment history into a risk-based survivorship plan that detects recurrence and new malignancy appropriately, prevents avoidable late harm and restores physical, psychological, reproductive and social function.
- Survivorship begins at diagnosis and includes recurrence surveillance, late-effect prevention, new-cancer risk, rehabilitation, medicine review and support for identity, work, relationships and finances.
- First-line survivorship assessment uses an end-of-treatment summary: histology and stage, surgery, systemic agents and cumulative doses, radiotherapy fields and dose, transplant, complications, genetics and current medicines.
- A treatment summary should generate a personalised care plan naming surveillance, late-effect tests, vaccination, health-promotion actions, red flags, contact routes and ownership between specialist and primary care.
- Follow tumour-specific surveillance guidance rather than adding unproven scans or tumour markers; symptom-triggered investigation remains essential between scheduled reviews.
- Anthracyclines and chest radiotherapy can cause cardiomyopathy, coronary, valve and pericardial disease years later; cardiovascular risk-factor control and exposure-based surveillance are central.
- Pelvic, gonadal, cranial and neck treatment can cause infertility, sexual dysfunction, thyroid or pituitary failure and bone loss; ask directly because symptoms may be gradual or embarrassing.
- Therapy-related myeloid neoplasms and radiation-field solid cancers are uncommon but important; persistent cytopenia or a new focal alarm feature needs a fresh diagnostic pathway.
- Manage fatigue by looking for recurrence, anaemia, endocrine disease, sleep disorder, pain, mood and deconditioning, then use paced exercise and rehabilitation rather than a single supplement or stimulant.
Key red flags
Progressive focal pain, unexplained weight loss, a new mass, bleeding or organ-specific alarm symptoms require investigation rather than attribution to survivorship anxiety.
New exertional breathlessness, orthopnoea, chest pain or palpitations after anthracycline, HER2 therapy or chest radiotherapy may represent treatment-related cardiovascular disease.
Syncope, hypotension, vomiting, hyponatraemia or hypoglycaemia after cranial, pituitary or adrenal treatment raises endocrine failure.
Persistent cytopenia, bruising or recurrent infection after cytotoxic therapy may reflect marrow failure, therapy-related myeloid neoplasm or another haematological disorder.
Severe distress, suicidal thought, substance dependence, inability to work or disabling fear of recurrence needs active assessment and support, not reassurance alone.
Investigation priorities
Identify the exposures that determine surveillance and late-effect risk.
Management branches
A phase of curative or intensive cancer treatment ends.
- Provide the patient and primary care team with diagnosis, stage, treatments, cumulative exposures, toxicities, ongoing medicines, genetic findings and devices or altered anatomy.
- Convert each relevant exposure into a recurrence schedule, late-effect surveillance item, vaccination or prevention action, with exact owner and next date.
- Explain red flags, urgent and routine contact routes, employment and activity advice, and arrange a treatment summary review when information is missing or circumstances change.